Gehi Anil K, Duong Truong D, Metz Louise D, Gomes J Anthony, Mehta Davendra
The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York 10029, USA.
J Cardiovasc Electrophysiol. 2006 Jun;17(6):577-83. doi: 10.1111/j.1540-8167.2006.00455.x.
We performed a meta-analysis of prognostic studies of patients with a Brugada ECG to assess predictors of events.
The Brugada syndrome is an increasingly recognized cause of idiopathic ventricular fibrillation; however, there is wide variation in the prognosis of patients with the Brugada ECG.
We retrieved 30 prospective studies of patients with the Brugada ECG, accumulating data on 1,545 patients. Summary estimates of the relative risk (RR) of events (sudden cardiac death [SCD], syncope, or internal defibrillator shock) for a variety of potential predictors were made using a random-effects model. The overall event rate at an average of 32 months follow-up was 10.0% (95% CI 8.5%, 11.5%). The RR of an event was increased (P < 0.001) among patients with a history of syncope or SCD (RR 3.24 [95% CI 2.13, 4.93]), men compared with women (RR 3.47 [95% CI 1.58, 7.63]), and patients with a spontaneous compared with sodium-channel blocker induced Type I Brugada ECG (RR 4.65 [95% CI 2.25, 9.58]). The RR of events was not significantly increased in patients with a family history of SCD (P = 0.97) or a mutation of the SCN5A gene (P = 0.18). The RR of events was also not significantly increased in patients inducible compared with noninducible by electrophysiologic study (EPS) (RR 1.88 [95% CI 0.62, 5.73], P = 0.27); however, there was significant heterogeneity of the studies included.
Our findings suggest that a history of syncope or SCD, the presence of a spontaneous Type I Brugada ECG, and male gender predict a more malignant natural history. Our findings do not support the use of a family history of SCD, the presence of an SCN5A gene mutation, or EPS to guide the management of patients with a Brugada ECG.
我们对Brugada心电图患者的预后研究进行了荟萃分析，以评估事件的预测因素。
Brugada综合征是特发性室颤日益被认识的病因；然而，Brugada心电图患者的预后存在很大差异。
我们检索了30项关于Brugada心电图患者的前瞻性研究，积累了1545例患者的数据。使用随机效应模型对各种潜在预测因素的事件（心源性猝死[SCD]、晕厥或体内除颤器电击）相对风险（RR）进行汇总估计。平均随访32个月时的总体事件发生率为10.0%（95%CI 8.5%，11.5%）。有晕厥或SCD病史的患者发生事件的RR增加（P<0.001）（RR 3.24[95%CI 2.13，4.93]），男性与女性相比（RR 3.47[95%CI 1.58，7.63]），以及自发出现与钠通道阻滞剂诱发的I型Brugada心电图的患者相比（RR 4.65[95%CI 2.25，9.58]）。有SCD家族史（P=0.97）或SCN5A基因突变（P=0.18）的患者发生事件的RR没有显著增加。与电生理检查（EPS）不可诱发的患者相比，可诱发的患者发生事件的RR也没有显著增加（RR 1.88[95%CI 0.62，5.73]，P=0.27）；然而，纳入的研究存在显著异质性。
我们的研究结果表明，晕厥或SCD病史、自发I型Brugada心电图的存在以及男性性别预示着更恶性的自然病程。我们的研究结果不支持使用SCD家族史、SCN5A基因突变的存在或EPS来指导Brugada心电图患者的管理。
